Harassment/Bullying Investigation and Intervention Planning
Prepared by Diana Browning Wright, M.S., L.E.P.
According to the Office of Civil Rights, (see: 2000 & 2010 OCR Dear Colleague Letters) regardless of a school’s name for the behavior (bullying, harassment, hazing, fighting, etc.) when the event(s) indicate civil rights have been abridged, school administrators must look beyond simply disciplining the perpetrator(s) and take action to eliminate the “hostile environment created by the harassment, address its effects, and ensure that it does not recur”. The following guidelines and documentation process will help site administrators document their efforts to assist both victim and harasser and demonstrate that the school is not “willingly indifferent” to the harassment. The following sections are in alignment with the OCR guidance letters as well as RTI for behavior principles for externalizing and internalizing behaviors.
Staff completing this form:
Section 1: Fact Finding
Person(s) involved in events under investigation:- Name of possible victim:
- Name of potential harasser(s) or perpetrator(s) of bullying
- Name(s) of bystanders or observers:
Who reported the behavior? When?
How was the behavior reported?
Behavior being investigated:
Statements made by potential harasser or perpetrators of bullying:
Statements made by possible victim:
Statements from bystanders or observers:
Statements from person(s) reporting events under investigation:
Interview History and Dates:
Staff interviewing possible victim:
Staff interviewing potential harassers/perpetrators:
Staff interviewing harasser’s/perpetrator’s teachers and other staff:
Staff interviewing bystanders or observers:
Staff interviewing possible victim’s teachers and other staff:
Staff interviewing parents or other stakeholders:
Who was interviewed?When?
Description of event(s) from interviews:(location, person(s) present, time of day, etc.)
DECISION: Was reported behavior harassment or bullying or other?
A. Harassment: The behavior victimized a member of a civil rights protected group: sexual harassment, sexual orientation harassment (perceived or acknowledged) or other covered civil rights protections: religion, ethnicity, race, disability (disability can be visible or invisible/ based on IEP, 504 plan, or other).
- The behavior was harassment.Yes No
- Protected Group:
If the behavior was harassment, skip Item B. below. Go to Section 2.
B. Bullying: Behavior was not harassment. It was not a behavior affecting a protected membership class that created a hostile environment for the victimized student, but may meet criteria for bullying, i.e., aggression, dominance, or victim has aperceived inability to make it stop and thus may require interventions beyond disciplining of the perpetrator.
- Behavior was bullying and requires both disciplinary action and follow-up.Yes No
- Behavior was a fight that requiresdisciplinary actionand/or follow-up.Yes No
- Behavior was teasing, mean-spirited “teasing,” inappropriate joking, etc.,
that requires disciplinary action and/or follow-upYes No
- Behavior was .Yes No
This event requires follow-up actions and/or interventions Yes No
If the behavior was bullying, go to Section 2. For all other behaviors, go to Section 3.
Section 2: Effects of Harassment or Bullying
Did the problem behavior affect victim’s behavior? (Examine: Absent or poorly prepared assignments, participation with peers, absenteeism, externalizing behaviors, internalizing behaviors, etc.) Yes No
Why or why not?
If yes, describe effects:
Effects were reported by:
Extent of effects: (include duration, intensity, frequency)
Did the problem behavior impact the victim’s academic performance? Yes No
Why or why not?
If yes, describe:
Impact on academic performance:
Provision for make-up work: (what work, what provision)
Additional instruction: (by whom, what topics, dates, and duration)
Did the problem behavior impact the victim’s social emotional well-being? Yes No
Why or why not?
If yes, describe:
Impact on social emotional well-being
Provision for service: (what service, duration, with whom, goals)
If the behavior was determined to be harassment, was a“hostile environment” created for the student?
Yes No
Section 3: Follow-Up Actions and Interventions
Bullying Harassment Other
Check () all that apply and describe:
No follow up or interventions needed: Rationale:
Discipline of the student with problem behaviors:
Law enforcement notification of events(note: notifying law enforcement alone is not a legally sufficient school administrator action to address or prevent reoccurrence or to demonstrate the school is not “willingly indifferent”, (Davis v. Monroe) but may be warranted to determine if laws have been broken, e.g., assault, battery, stalking, terroristic threats, hazing, etc.)
Date of contact: Badgenumber of officer:
Parent meeting(s):
For victim: (With whom, by whom, outcome)
For harasser/perpetrator: (With whom, by whom, outcome)
Tier 1: Separation of harasser/perpetrator and victim: (describe how, duration, who supervises)
Tier 1: Brief counseling of victim: (describe content, duration, service provider)
Tier 1: Brief counseling ofharasser/perpetrator: (describe content, duration, service provider)
Tier 1: Future scheduled conferences with victim and family: (how frequently, by whom)
Tier 1: Future scheduled conferences with harasser/perpetrator and family:(how frequently, by whom)
Tier1: Limitation of freedom of movement for harasser/perpetrator during less supervised times(yard, hallways, restrooms, etc.) with progression to normal freedom of movement by demonstrating appropriate behavior: (progression: physical nearness to supervising adult, to auditory range of adult, to visual range of adult, to normalization of freedom of movement)
Supervised by:
Date to Begin: Expected Termination Date:
Tier 2: Training for Victim on:
Conducted by: Duration: Date to Begin:
Tier 2: Training for Harasser/perpetrator on:
Conducted by: Duration: Date to Begin:
Tier 2: Structured daily mentoring: (such as Check-in/Check-out, Behavior Education Program)
For Victim: Mentor: Date to Begin:
For Harasser/perpetrator: Mentor: Date to Begin:
Tier 2: Behavioral Contract for Harasser/perpetrator:
Established and monitored by: Date to Begin:
Tier 2 or 3: Small group or individualSocial Skills Training for Victim, including positive peer reporting techniques
Conducted by: Date to Begin:
Tier 3: Individual Social Skills Training for Harasser/perpetrator(do not use small group due to deviant peer contagion effects):
Conducted by: Date to Begin:
Tier 3: Cognitive Behavioral Therapy, Function-based Behavior Plan, Family Services, or other high intensity direct service provision (Consult Student & Family Services):
For Victim: (include intervention rationale, goals, in school or private service provider, dates, duration, communication methods with other agencies, etc.)
For Harasser/perpetrator: (include intervention rationale, goals, in school or private service, service provider, dates, duration, communication methods with other agencies, etc.)
Section 4: Documentation of Follow-up Actions
- Steps taken to ensure victim and family know how to report future events:
- Schedule of follow-up inquiries to determine whether there have been any new/additional incidents or instances of retaliation:
- Further communication is required for students with special needs:
Copy of this finding has been sent: By whom: Date Sent:
To Director of Special Education:
To District Coordinator for Section 504:
Other: (specify)
Section 5: Consideration of District and Whole School Actions
If Harassmentor Bullying was Determined
Check () all that apply and describe:
No action needed. Rationale
Whole school training to improve recognition of harassment and bullying and prompt responding:
Date(s):
Topic(s):
Presenter(s):
Whole community of stakeholders (parents, community, students, staff) training on how to recognize and promptly report harassmentor bullying:
Date(s):
Topic(s):
Presenter(s):
Increased staff supervision on campus/playground/yard/bus:
Initiated by: Date(s):
Description of changes:
Training of campus/playground/yard/bus supervising staff:
Date(s):
Topic(s):
Presenter(s):
Issuing or re-issuing written school policy on harassment/bullying and delineation of reporting methods:
Check all who will receive policy and reporting information: Staff Students Families
To be issued/re-issued bywhom: Date(s):
Conflict Resolution Systems training for playground/yard peers:
Staff Trainers: Timeline:
Programs to use:
Potential training participants: Date(s):
© Diana Browning Wright,may be duplicated for non-commercial purposes, v.1 20121 | Page